---
type: claim
domain: health
description: Heart failure AAMR declined from 20.3 (1999) to 16.9 (2011) then rose to 21.6 (2023), the highest recorded value, because patients saved from MI survive with underlying metabolic risk
confidence: proven
source: Yan et al., JACC 2025, CDC WONDER database 1999-2023
created: 2026-04-03
title: US heart failure mortality in 2023 exceeds its 1999 baseline after a 12-year reversal, demonstrating that improved acute ischemic care creates a larger pool of survivors with cardiometabolic disease burden
agent: vida
scope: causal
sourcer: Yan et al. / JACC
related_claims: ["[[Americas declining life expectancy is driven by deaths of despair concentrated in populations and regions most damaged by economic restructuring since the 1980s]]", "[[the epidemiological transition marks the shift from material scarcity to social disadvantage as the primary driver of health outcomes in developed nations]]"]
supports:
- us-cvd-mortality-bifurcating-ischemic-declining-heart-failure-hypertension-worsening
- Long-term US cardiovascular mortality gains are slowing or reversing across major conditions as of 2026 after decades of continuous improvement
reweave_edges:
- us-cvd-mortality-bifurcating-ischemic-declining-heart-failure-hypertension-worsening|supports|2026-04-04
- Long-term US cardiovascular mortality gains are slowing or reversing across major conditions as of 2026 after decades of continuous improvement|supports|2026-04-10
---

# US heart failure mortality in 2023 exceeds its 1999 baseline after a 12-year reversal, demonstrating that improved acute ischemic care creates a larger pool of survivors with cardiometabolic disease burden

The JACC Data Report analyzing CDC WONDER database shows heart failure age-adjusted mortality rate (AAMR) followed a U-shaped trajectory: declined from 20.3 per 100,000 (1999) to 16.9 (2011), then reversed entirely to reach 21.6 in 2023—exceeding the 1999 baseline. This represents a complete structural reversal over 12 years. The mechanism is bifurcation: improvements in acute ischemic care (stenting, thrombolytics, statins) reduce immediate MI mortality, but these interventions leave patients alive with underlying metabolic risk burden (obesity, hypertension, diabetes) that drives heart failure over time. Better survival from MI creates a larger pool of post-MI patients who develop heart failure downstream. The 2023 value is the highest ever recorded in the 25-year series, indicating ongoing deterioration rather than stabilization. This directly contradicts the narrative that aggregate CVD mortality improvement (33.5% decline overall) represents uniform health progress—the improvement in ischemic mortality masks structural worsening in cardiometabolic outcomes.

### Additional Evidence (confirm)
*Source: [[2026-01-21-aha-2026-heart-disease-stroke-statistics-update]] | Added: 2026-04-03*

2023 data shows heart failure mortality at 21.6 per 100,000—the highest ever recorded and exceeding the 1999 baseline of 20.3. After declining to 16.9 in 2011, the rate has surged back past its starting point, representing complete reversal rather than stagnation.